October 2, 2019
Today’s Top Story

Study: Safety and Efficacy of One-stage Sequential Bilateral TKA

A study published online in The Journal of Arthroplasty found that one-stage single anesthetic sequential bilateral total knee arthroplasty (BTKA) may be safer than previously reported. The researchers compared patients undergoing BTKA and unilateral TKA (UTKA). Two patient groups (n = 394 for each) were propensity-matched for sex, age, body mass index, American Society of Anesthesiologists (ASA) grade, and Veterans Rand-12 health survey scores. The primary outcome was morbidity and mortality. Satisfaction outcomes were determined using patient-reported outcome measures (PROMs). A single case of mortality was recorded in the BTKA group. The rate of pulmonary embolism (PE) was higher in the BTKA group (2.0 percent) than the UTKA cohort (0.3 percent); PE was significantly associated with an ASA grade of 3 or greater. The rate of minor complications did not largely differ between the groups; blood transfusion rates were low and comparable between groups (BTKA, 2.5 percent versus UTKA, 1.3 percent). Mean hospital length of stay was 1.3 days longer in the BTKA group. Final PROMs showed significant improvement and were comparable between groups.

Read the abstract…

In Other News

Study Evaluates Opioid Disposal Practices and Education in the United States

A study published in the September/October issue of Current Orthopaedic Practice observed low rates of unused opioid acceptance and pharmacy-patient education regarding options to return unused opioids. The researchers contacted every U.S. children’s hospital pharmacy (n = 188), as well as a large sample of chain (n = 436) and nonchain (n = 422) pharmacies and police stations (n = 421) in every state to ask whether each facility accepted unused opioids. A total of 1,477 phone calls were successfully made. Of the facilities contacted, 415 (28 percent) said they accepted unused opioids; police stations had a significantly higher acceptance rate (60 percent) than pharmacies (15 percent) and children’s hospitals (11 percent). Significant discrepancies were observed between pharmacy types: Independent pharmacies had a higher take-back rate (24 percent) than retail pharmacies (7 percent). Children’s hospital pharmacies were significantly more likely to report recommending proper disposal of unused opioids at the time of medication dispensing compared to chain and nonchain pharmacies (78 percent versus 29 percent).

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Study: PODCI and PROMIS Domains in Congenital Upper Limb Anomalies

A study published online in The Journal of Hand Surgery analyzed the perceived functional and psychosocial impact of upper limb congenital anomalies before surgery using the Pediatric Outcomes Data Collection Instrument (PODCI) and Patient-reported Outcomes Measurement Information System (PROMIS) domains. Data were collected from the Congenital Upper Limb Differences study group, and anomalies were categorized per the Oberg-Manske-Tonkin classification. PODCI subscales of upper-extremity (UE) function, pain/comfort, and happiness and PROMIS domains of UE function, pain, depression, anxiety, and peer relations were assessed. Final analysis included 359 patients (average age, 10 years; 55 percent were male), of whom 241 had an entire limb malformation and 231 had a hand plate malformation; 118 patients had dysplasia, 45 had a syndrome, and four had a deformation. The PODCI and PROMIS ceiling and floor effects for the UE domains did not largely differ, and the ceiling effect for PROMIS pain domain was comparable to the floor effect of the PODCI pain subscale. The floor effect of PODCI happiness and PROMIS depression domains did not significantly differ. The UE and pain domains and PODCI happiness and PROMIS depression subscales achieved convergent validity.

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Study: Relationship Between Hip Internal Rotation and Upper-extremity Pain in Young Baseball Players

A study published online in the Journal of Shoulder and Elbow Surgery observed a correlation between restricted internal rotation of the hip and elbow and shoulder pain in young baseball players. Patients aged nine to 12 years who participated in the National Junior Sports Clubs Baseball Festival were evaluated for range of motion in external and internal rotation of the hip, finger-to-floor distance, and heel-to-buttock distance. They also completed the straight-leg-raise test and Star Excursion Balance Test (SEBT). Final analysis included 177 patients, of whom 16 (9 percent) reported elbow or shoulder pain during the tournament. Compared to those who did not report pain, patients with elbow or shoulder pain had significantly reduced hip internal rotation of the stride leg (43.7 degrees versus 35.8 degrees). Other joint flexibilities and the SEBT were not significantly correlated with elbow or shoulder pain.

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Orthopaedic Surgeon Charged for Illegal Opioid Prescriptions

Evangelos Megariotis, MD, an orthopaedic surgeon and owner and operator of Orthopedic Associates, was charged for illegally prescribing oxycodone, Percocet, Xanax, and promethazine with codeine “outside the usual course of medical practice,” according to the Department of Justice (DOJ). Dr. Megariotis is accused of prescribing more than 1.4 million oxycodone tablets and more than 450 gallons of promethazine with codeine cough syrup over the course of two years. He allegedly wrote prescriptions to patients he knew were abusing opioids.

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Read the DOJ press release…


Long Hours, Insulated Specialties Result in Lateral Violence in Residency

Lateral violence can take many forms, including complaints, commiseration, work sabotage, or efforts to gain position or control over a coworker. When hours are long and work requirements are voluminous, the environment is ripe for such activities. In the first of a two-part series, this article explores the ways lateral violence may occur in residency training, provides real-world examples from residents in training, and discusses the potential negative effects on residency programs, as well as corrective measures.

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Final Call: Take Part in an AUC Workgroup

AAOS is seeking volunteers to take part in a workgroup for the development of appropriate use criteria (AUC) for The Early Screening for Psychosocial Risk and Protective Factors. The deadline to submit an application for this project is Oct. 4.

Learn more and submit your application…


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